PHLR Annual Meeting: Update on Community Benefit Requirements

Jason Turner, PhD, a professor at the Saint Louis University School of Public Health, is the recipient of a Public Health Law program grant to study community benefit activities conducted by non-profit hospitals. These activities are required to maintain a hospitals’ tax-exempt status. Turner spoke at this week’s Public Health Law Research annual meeting about community benefit and NewPublicHealth checked in with him for an update.

>>Read a related Q&A with Abbey Cofsky, program officer at the Robert Wood Johnson Foundation, about public health opportunities from community benefit requirements.

NewPublicHealth: What is the scope of your grant?

Jason Turner: We’re looking specifically at the impact that state regulations have on the type of community benefit being provided. We’ll be presenting what the national picture looks like. We’ll also show a comparison between [different levels of] rigor of state reporting requirements—for example, does a hospital simply have to state that it has a community benefit program, or does it have to state specifically what the benefit program entails.

What we have found is that there is not one standard. Eighteen to nineteen states have community benefit regulations. The majority of state regulations are flexible—you just have to file your community benefit program with the state. Some, though, such as Texas, are very strict and require that hospitals meet a particular threshold, or be stripped of their nonprofit status within the state.

NPH: Will you be making recommendations for what you think states should ask hospitals for in order to qualify for the community benefit exemption?

Jason Turner: We’re moving in that direction, but we don’t have anything just yet we’re ready to present. It’s larger than just the requirement piece. We’re looking at the demographics of the community, the income level of the community and other factors that have the potential to influence the provision of community benefit practices. We’re also looking at competition from other hospitals in the area and how that might impact the provision of community benefit. The concern is that if we come out and say that every hospital should do certain types of things that may not be for the best. [We expect that] one size does not fit all. For example, if you’ve got a community hospital in a rural area, if I say a particular facility should be providing thirty percent of its community benefit in medical education or charity care to receive its nonprofit status, for that facility those provisions may not be the appropriate buckets. And if they’re forced to provide those benefits they may ultimately go under.

NPH: Have you seen positive impact from community benefit requirements that emphasize greater accountability?

Jason Turner: Yes. Those states that are much more explicit in setting out what they want to see as community benefit provisions get what they want. So, for example, because of specific provisions, hospitals in Texas spend more on charity care and less on Medicaid shortfall. If the idea is to steer community benefit activities toward particular areas, then states need to be very explicit.

NPH: Your presentation at the PHLR meeting is just a small piece of your larger grant work?

Jason Turner: Yes, we’re looking at the current state of community benefit, but we’re also looking at the internal and environmental factors that influence the provision of community benefit and we’re reviewing hospitals in order to do a quality check—we’ll do some quality research to see specifically how community benefit is provided in particular states.

Some of the provisions we’ve found are hospital-centric, such as the hospital’s bottom line, and have less to do with the overall population health of the community in which they reside. I’m a big fan of community health improvement that focuses on improving the health of the community. And often that’s what sets apart the not-for-profit hospitals from the investor-owned ones.

This commentary originally appeared on the RWJF New Public Health blog.